Diabetes mellitus is a metabolic disorder that causes damage to the heart, brain, kidneys, and other vital organs, and if it is combined with hypertension, the damage to these vital organs is even faster. Many large clinical studies have shown that good control of blood pressure in diabetic patients has a greater effect on reducing cardiovascular and cerebrovascular complications of diabetes than good control of blood glucose. For example, the UKPDS study found that a 10/5 mmHg reduction in blood pressure reduced diabetes-related deaths by 32%, all macrovascular lesions by 34%, strokes by 44% (p = 0.013), myocardial infarction by 21%, heart failure by 56%, retinopathy progression by 34%, visual deterioration by 47%, microalbuminuria by 29%, and significant The reduction in proteinuria was 39%. Therefore, patients with diabetes must pay attention to the treatment of hypertension. The treatment principle of diabetes combined with hypertension Patients with diabetes combined with hypertension should select and adjust antihypertensive drugs in a timely manner under the guidance of a physician on the basis of lifestyle interventions, starting with small doses, taking individualized medication, taking advantage of the synergistic effect between drugs when combined medication is needed, and taking multiple drugs in small doses, avoiding the long-term use of one drug in large doses. Blood pressure should be controlled to the ideal target of less than 130/80 mmHg as much as possible according to the patient’s condition. If proteinuria is also present, the blood pressure should be less than 125/75 mmHg, but the diastolic blood pressure should not be less than 60 mmHg in general, and preferably not less than 70 mmHg for combined coronary artery disease. If combined with acute cerebral infarction, do not rush to lower blood pressure treatment, and adjust antihypertensive drugs under the professional guidance of a neurologist. Blood pressure should be monitored regularly and at multiple time points, whether early in the morning, in the morning and afternoon, or at night, and never take antihypertensive drugs based on one’s own feelings, as many patients have no symptoms despite life-threateningly high blood pressure. Lifestyle interventions lay the foundation for antihypertensive treatment Diabetic patients with combined hypertension should pay attention to the role of lifestyle interventions to lower blood pressure. Lifestyle interventions can not only prevent hypertension but can also lead to a mild decrease in already elevated blood pressure. Some patients rely exclusively on antihypertensive medications without focusing on lifestyle improvements, often making it difficult to control blood pressure to desired levels. The Seventh Congress of the American Hypertension League reported that the main lifestyle modifications to lower blood pressure are: ① reducing weight in overweight and obese people; ② using dietary therapy to end hypertension, i.e., consuming more fruits (diabetic patients can consume small amounts), vegetables and low-fat milk products with less unsaturated fat and total fat content, which can lower systolic blood pressure by 8 to 14 mm Hg; ③ daily sodium chloride intake of less than 6 grams, which can lower (3) daily sodium chloride intake of less than 6 grams can reduce systolic blood pressure by 2-8 mm Hg; (4) participation in regular aerobic exercise can reduce systolic blood pressure by 4-9 mm Hg. In addition, maintaining a happy mood and avoiding mental tension are also very important for stabilizing blood pressure. Clinically used antihypertensive drugs Clinically used antihypertensive drugs mainly include: diuretics (such as hydrochlorothiazide, indapamide), calcium antagonists (such as amlodipine besylate, lercanidipine hydrochloride, felodipine extended-release tablets, lacidipine, nifedipine controlled-release tablets), beta-blockers (such as atenolol, metoprolol tartrate, bisoprolol fumarate), angiotensin-converting enzyme inhibitors (such as fosinopril, perindopril, benazepril, ramipril), angiotensin II receptor antagonists (e.g., valsartan, coxsartan, telmisartan, irbesartan, candesartan), and alpha-receptor antagonists (e.g., methyldopa, terazosin hydrochloride). All of these antihypertensive drugs can be used in diabetic patients, but try to choose those that have little negative impact on blood glucose, blood lipids, and on diabetic complications. The first choice is angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and calcium antagonists. For calcium antagonists, long-acting dihydropyridines or non-dihydropyridines, such as diltiazem, nifedipine controlled-release tablets, and amlodipine tablets, are preferred to reduce the reflex sympathetic activation effect. Currently commonly used antihypertensive drug combinations Under the premise of glycemic control, the pharmacological treatment of diabetes combined with hypertension should follow the principle of individualized treatment. Although increasing the dose can improve the efficacy, it also increases the incidence of adverse reactions. Most patients with diabetes mellitus combined with hypertension require a combination of medications to achieve tight blood pressure control and keep blood pressure below 130/80 mmHg. The combination regimen can be selected rationally based on the patient’s blood pressure and comorbidities. Generally, two to three, or even more, drugs can be used in combination. The combination of two (or more) different antihypertensive drugs is usually advocated to improve the antihypertensive effect and reduce the adverse effects of individual use. The recommended combination scheme is as follows: angiotensin-converting enzyme inhibitor (or angiotensin II receptor antagonist) + calcium antagonist; angiotensin-converting enzyme inhibitor (or angiotensin II receptor antagonist) + diuretic; calcium antagonist + beta-blocker; beta-blocker + diuretic; beta-blocker + alpha-receptor antagonist. Among them, angiotensin-converting enzyme inhibitors (or angiotensin II receptor antagonists) + calcium antagonists can be the first choice of combination drugs, because the combination of the two has the effect of improving vascular endothelial function and insulin sensitivity, exerting anti-atherosclerotic effects, protecting renal function, and reducing proteinuria, etc. The results of the Accomplish evidence-based medical study published in 2008 also proved that angiotensin-converting enzyme inhibitors + calcium antagonists can be used as a combination drug. The results of the 2008 Accomplish evidence-based study also demonstrated that angiotensin-converting enzyme inhibitors + calcium antagonists reduce cardiovascular risk in patients with diabetes combined with hypertension better than angiotensin-converting enzyme inhibitors + diuretics. ”Cocktail therapy” reduces cardiovascular accidents associated with hypertension The so-called “cocktail therapy” is the simultaneous or phased use of multiple therapeutic agents for the same disease in response to multiple risk factors and different pathogenesis, thus providing a comprehensive, integrated treatment. The so-called “cocktail therapy” is the simultaneous or phased application of multiple therapeutic drugs to the same disease in response to multiple risk factors and different pathogenesis, thus playing a comprehensive and integrated treatment role. In other words, through the popularization of health knowledge, we can raise patients’ awareness of the disease and take correct measures to prevent and treat the disease; under the guidance of doctors, we can select multiple drugs suitable for the disease to control various risk factors that cause cardiovascular accidents, such as hypertension, dyslipidemia, hyperglycemia, obesity and hypercoagulability, from the source, so as to achieve multi-target and multi-angle intervention to prevent and reduce the occurrence of cardiovascular and cerebrovascular events. The Danish Steno-2 study focused on the effect of intervention of multiple risk factors on cardiovascular disease in patients with type 2 diabetes. A total of 80 patients were enrolled in the conventional treatment group and received conventional treatment according to guidelines; 80 patients were also enrolled in the intensive treatment group and were treated progressively with behavioral interventions and medications for hyperglycemia, hypertension, abnormal lipids, and microproteinuria to achieve target values, and aspirin was used as secondary prevention. The microangiopathy endpoint was statistically evaluated at study year 4, the macroangiopathy endpoint at year 8, and the mortality endpoint event at the end of the 13-year study follow-up. Just over the course of follow-up, 35 patients in the conventional treatment group had 85 cardiovascular events, while only 19 patients in the intensive treatment group had 33 events. The results of the Steno-2 study suggest that comprehensive control of multiple risk factors in patients with diabetes is an important guarantee of patient benefit.